Recently, the diagnosis of occult frac- tures has been facilitated due to
increased availability and utilization of MRI. Diagnosing a fracture of the
ischiopubic rami from a proximal femoral fracture, in particular, is difficult
using physical exam alone and can be facilitated by having access to an MRI.
Here we report both physical exam findings and MRI findings that help in
differentiating occult fractures of the iliopubic rami. Materials and Methods:
From April 2010 to December 2012, we identified 30 pa- tients (5 male and 25
female; aged 43 - 93 years old). We recorded if a traumatic episode occurred,
ambu- latory status at the initial visit (bed ridden, standing up with an aid,
walking with an aid). We also re- corded if imaging was used in determining the
final diagnosis (radiographs, MRI or CT).
Results: Twenty- one patients had a fracture as a result of a traumatic
episode. In the remaining 9 cases, no trauma oc- curred and therefore the
fractures were insufficiency fractures. Ten patients were bed ridden at the
initial visit, eight patients were able to stand only with a walking aid, and
the remaining twelve patients were able to walk with an aid. Occasional
radiographs were used to confirm the presence of a fracture in 4 cases, MRI in
11 cases, and CT scan in 15 cases. Dis- cussion and Conclusions: Occult
fractures of the is- chiopubic rami can occur without trauma and it can be
difficult to differentiate these fractures from occult proximal femoral
fractures. In these cases, MRI is useful to definitively obtain a diagnosis. In
cases of pacemaker, bullet implantation or artificial hip joints, CT or
occasional radiographs are also useful to diag- nose occult fractures of the
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